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In this video series, doctors at The Children's Hospital of Philadelphia describe treatment options for a heart with tetralogy of Fallot (TOF).
The upper chamber of the heart is opened, and working through the valve that enters the right side of the heart, the hole between the two pumping chambers of the heart is closed with a patch. The patch is made out of a sort of fuzzy Dacron material. So the lining of the heart grows over that and makes it nice and smooth.
There can be blockage below the pulmonary valve inside the ventricle from big muscle bundles. The pulmonary valve itself can actually be blocked. The pulmonary valve has three leaflets which open and if they're fused together, that can cause a blockage because they can't open completely. Sometimes just by separating the leaflets you can open up the valve. The pulmonary valve is a circle and the outer layer, that's called the "annulus." If that's very small, even if you open up the leaflets, it's like having a small tube. It may be too little. And then you can also have blockage out in the pulmonary arteries themselves. So you can have blockage below the valve, at the valve, and above the valve.
Sometimes, if the artery to the lungs is quite small, it's enlarged by opening it and putting a small patch over it to make it bigger so blood can easily get to the lungs.
That's called a "transannular patch." Some babies will tolerate that very well. Others will need a valve put in at some point in their life.
Because of the initial element of narrowing in the right ventricular outflow tract and the need to enlarge the narrowing, there can be leakage of the pulmonary valve.
And while that is very well tolerated, there are some people as they get into adulthood where the amount of that leakage causes the right side of the heart to enlarge, and they need to have an artificial valve put in on the right side of the heart.
Tetralogy of Fallot (TOF)
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